Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease

A Clinical Practice Guideline from the American College of Physicians

Published in: Annals of Internal Medicine, v. 147, no. 9, Nov. 6, 2007, p. 633-638

Posted on RAND.org on January 01, 2007

by Amir Qassem, Vincenza Snow, Paul G. Shekelle, Katherine Sherif, Timothy J. Wilt, Steven Weinberger, Douglas K. Owens

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In the United States, chronic obstructive pulmonary disease (COPD) affects more than 5% of the adult population and is the 4th leading cause of death and the 12th leading cause of morbidity. This guideline presents the available evidence on the diagnosis and management of COPD. The target audience is all physicians, and the target patient population is all adults with COPD. RECOMMENDATION 1: In patients with respiratory symptoms, particularly dyspnea, spirometry should be performed to diagnose airflow obstruction. Spirometry should not be used to screen for airflow obstruction in asymptomatic individuals. (Grade: strong recommendation, moderate-quality evidence.) RECOMMENDATION 2: Treatment for stable chronic obstructive pulmonary disease (COPD) should be reserved for patients who have respiratory symptoms and FEV1 less than 60% predicted, as documented by spirometry. (Grade: strong recommendation, moderate-quality evidence.) RECOMMENDATION 3: Clinicians should prescribe 1 of the following maintenance monotherapies for symptomatic patients with COPD and FEV1 less than 60% predicted: long-acting inhaled *-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids. (Grade: strong recommendation, high-quality evidence.) RECOMMENDATION 4: Clinicians may consider combination inhaled therapies for symptomatic patients with COPD and FEV1 less than 60% predicted. (Grade: weak recommendation, moderate-quality evidence.) RECOMMENDATION 5: Clinicians should prescribe oxygen therapy in patients with COPD and resting hypoxemia (Pao2 55 mm Hg). (Grade: strong recommendation, moderate-quality evidence.) RECOMMENDATION 6: Clinicians should consider prescribing pulmonary rehabilitation in symptomatic individuals with COPD who have an FEV1 less than 50% predicted. (Grade: weak recommendation, moderate-quality evidence.)

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